In conclusion, we have found that the hands of anesthesia providers are contaminated immediately before patient care with a wide range of bacterial pathogens. Furthermore, contamination of patient IV tubing and the immediate patient environment is common in the intraoperative setting and is partially explained by bacterial transmission from the contaminated hands of anesthesia providers. Contamination of provider hands before patient care therefore represents an important modifiable risk factor for bacterial cross-contamination. These findings support initiatives designed to improve intraoperative hand hygiene of anesthesia providers both before and during patient care, as well as intraoperative decontamination strategies. These findings also challenge the commonly held belief by physicians that they play little or no role in bacterial transmission.19